Efficacy of octreotide for management of lymphorrhea after pelvic lymph node dissection in radical prostatectomy

Abstract

OBJECTIVES: To examine the efficacy of octreotide for management of lymphorrhea after pelvic lymph node dissection (PLND) in radical prostatectomy. Lymphorrhea refers to the drainage of lymphatic fluid that occurs because of surgical dissection and inadequate closure of afferent lymphatic vessels.

METHODS: We enrolled 89 patients from whom more than 200 mL of lymphorrhea had been drained at postoperative day (POD) 3 after PLND. Of the 89 patients, 45 were managed by conservative methods (untreated group) without the injection of octreotide in the earlier period, and the remaining 44 received injections of octreotide (treated group) in the later period. Octreotide was injected subcutaneously 3 times a day, starting on POD 3. Pelvic drains were removed when the total drainage per day was less than 50 mL. Octreotide was also injected for 1-2 days after drain removal. We compared mean age, prostate-specific antigen, Gleason score, daily amount of lymphorrhea, duration of drain placement, hospital stay, number of harvested lymph nodes (LNs), number of positive LNs, and complications between the 2 groups.

RESULTS: The mean age, prostate-specific antigen, Gleason score, amount of lymphorrhea at POD 3, number of harvested LNs, and the number of positive LNs were not significantly different between the 2 groups. Patients treated with octreotide produced significantly less lymphorrhea daily (205.7 +/- 231.3 mL in untreated group, 95.2 +/- 128.7 mL in treated group) (P <.001). The duration of drainage placement was significantly shorter in the treated group (8.9 +/- 1.9 days) than in the untreated group (12.1 +/- 3.8 days) (P <.001). The hospital stay was also significantly shorter in the treated group (9.9 +/- 3.1 days) than in the untreated group (14.9 +/- 3.9 days) (P <.001). There were no significant systemic side effects of octreotide. Lymphoceles occurred in 8 cases in the untreated group and 2 cases in the treated group.

CONCLUSIONS: The injection of octreotide is an effective and safe treatment for the management of lymphorrhea after PLND. Additional studies are needed to determine optimal dosage and treatment regimens.